gms | German Medical Science

Objective: Patients suffering from intractable focal epilepsy due to bilateral lesions or in the scenario of extended epileptogenic lesions in the absence of hemiparesis are often excluded from epilepsy surgery. These children are especially often resistant to antiepileptic drugs and are at a high risk of developing severe cognitive impairment and behavioral abnormalities. Given the severe burden of epilepsy in this group, we considered surgery appropriate to improve the patients’ conditions. Here, we present data from 22 patients who underwent epilepsy surgery with a palliative indication.

Methods: Out of 311 patients who underwent epilepsy surgery between September 1998 and November 2010, retrospective data on 22 patients (f:11, m:11) are presented. All patients underwent video-EEG long-term monitoring at least once as well as high resolution MRI.

Results: 8 patients received palliative primary incomplete resections of the epileptogenic lesions, 13 patients received unilateral resections of bilateral lesions, and in 1 patient, both bilateral lesions were removed. Etiologies included: malformations of cortical development in 8, post-hypoxic and post-hemorrhagic brain damage in 10, post-encephalitis in 2, neoplastic brain tumor in 2 patients. Age at onset of epilepsy: 2.7 yrs (0.1–14), surgery: 7.5 yrs (1.2–19), postoperative follow-up 45.7 months (3–124). 8 children underwent hemispherotomy, 2 received subtotal hemispherical and 9 multilobar resections. 3 patients underwent frontal resections. Post-surgical seizure outcome: seizure-free: n = 12, > 90% seizure reduction: n = 2, > 50% seizure reduction: n = 7, unchanged: n = 1.

Conclusions: Patients can benefit from epilepsy surgery even with incomplete resection of the epileptogenic lesions. In the group analyzed, more than 50% of the patients enjoyed freedom from seizures. In addition, surgery resulted in a marked improvement in quality of life even for children without complete seizure relief.